Physical performance capacity after pediatric kidney transplant and clinical parameters associated with physical performance capacity

Cardiopulmonary fitness in children/adolescents with chronic kidney disease and the impact of exercise training: a systematic review and meta-analysis of observational study and randomized controlled trials

BACKGROUND

This systematic review and meta-analysis aimed to evaluate differences in cardiopulmonary fitness between healthy controls and children/adolescents with chronic kidney disease (CKD) and the effects of exercise training.

METHODS

PubMed, Embase, Scopus and Web of Science were searched for published studies from reception to 14 June 2023, and updated search on 15 October 2023. The included observational studies reported on cardiorespiratory fitness, included maximal oxygen uptake (VO2max), peak oxygen consumption (VO2peak) and 6-minute walk distance (6MWD), in children/adolescents with CKD and age-matched healthy controls, as well as clinical intervention trials of exercise training on cardiorespiratory fitness in samples of children and/or adolescents up to 19.

RESULTS

Fifteen observational studies and five clinical trials were included, respectively. The studies found that the mean cardiopulmonary fitness was 1.82 standardized mean differences (SMDs) units (95% confidence interval (95% CI) 1.43-2.20) lower in children/adolescents with CKD than in healthy controls or reference values. Except for pre-dialysis CKD patients, peritoneal dialysis, haemodialysis and kidney transplant recipients had significantly lower cardiorespiratory fitness than healthy controls. The results of a meta-analysis based on a pre-post single-arm trial showed that compared to baseline, exercise training improved the 6MWD by approximately 58.17 m (95% CI 16.27-100.06), with very low evidence.

CONCLUSIONS

This systematic review and meta-analysis of observational studies and clinical trials that included children/adolescents with CKD found that cardiorespiratory fitness is severely reduced in this population and that exercise training may be an effective strategy for improvement. Given the low evidence certainty, additional high-quality trials are necessary.

Balance in children with chronic kidney disease: the relationship between skeletal muscle mass index, fatigue, and physical function

BACKGROUND

The study evaluated the relationship between balance function and skeletal muscle mass index (ASMI), physical function, and fatigue in children with chronic kidney disease (CKD).

METHODS

A cross-sectional study of 83 children with CKD (stages 1-4, dialysis, transplant) and 71 healthy controls was conducted. Functional performance tests, including gait speed, 6-min walk distance (6MWD), five-repetition sit-to-stand (5RST), and timed up-and-go (TUG) tests, were administered. Quadriceps muscle strength (QMS) and hand grip strength (HGS) were assessed alongside bioelectrical impedance analysis (BIA) for muscle mass evaluation. Fatigue was measured using the Child Fatigue Scale, and balance was assessed using the Pediatric Balance Scale. Multivariate linear regression, performed exclusively on the CKD cohort, was used to determine factors influencing balance.

RESULTS

Children with CKD exhibited significantly lower muscle strength, physical performance, and balance than controls. Specifically, QMS on the right side was 7.16 ± 5.36 kg in the dialysis group versus 16.51 ± 8.66 kg in the CKD stages 1-4 group and 18.58 ± 7.27 kg in controls (p < 0.001). The 6MWD was 392 ± 50.34 m in the dialysis group compared to 476 ± 49.67 m in CKD stages 1-4 and 425 ± 68.94 m in controls (p < 0.001). Fatigue levels were highest in the dialysis group (41.00 ± 11.51), and balance scores were lowest in this group (47.71 ± 8.55) (p = 0.001 for both). Regression analysis showed that QMS (β = 0.333, p = 0.042), ASMI (β = 0.259, p = 0.043), gait speed (β = -0.347, p = 0.012), TUG (β = -0.656, p = 0.001), GFR (β = 0.238, p = 0.033), and lean mass (β = 0.710, p = 0.028) were significant predictors of balance.

CONCLUSIONS

The dialysis group presented the most significant reductions in ASMI, muscle strength, balance, and functional performance, alongside the highest fatigue levels. Balance was mainly influenced by fatigue, ASMI, QMS, and declining functional capabilities. Considering the negative impact of balance impairments on prognosis, early implementation of rehabilitation programs is essential for improving outcomes in CKD patients.

Late nephrectomy in infants with congenital nephrotic syndrome of the Finnish type

AIM

Bilateral nephrectomy is commonly performed in patients with congenital nephrotic syndrome of the Finnish type. The optimal timing of nephrectomy is unclear.

METHODS

Growth, thromboembolic events, infections, transplant-related complications and ability to eat were compared between infants with early (Group 1, n = 13) and late (Group 2, n = 10) nephrectomy. 'Early' was defined as nephrectomy at 7-kg body weight followed by peritoneal dialysis and 'late' as nephrectomy at ≥10 kg followed by 3-4 weeks of haemodialysis and kidney transplantation. Patients were followed until the end of the first post-transplant year.

RESULTS

Dialysis time was significantly longer in group 1 than in group 2. Late nephrectomy did not increase the risk for thromboembolic events or septicaemia but decreased tube feeding dependency (group 1 69% vs. group 2 20%, p = 0.019). Motor development at transplantation was considered normal in 80% of the infants with late nephrectomy compared to 31% in the early nephrectomy group (p = 0.019); however, the difference between the groups disappeared by the end of the follow-up.

CONCLUSION

Infants with late nephrectomy have comparative outcome but less feeding tube dependency and better motor development during the first post-transplant months compared to infants with early nephrectomy.

From designing minimum data set to developing kidney transplantation registry in Iran

Objective

Currently, population growth and increasing life expectancy are becoming one of the biggest public health challenges in the world, which has increased the prevalence of chronic diseases such as end-stage renal disease and the need for kidney transplantation. The use of a variety of registries has the potential to determine the effectiveness of clinical care and costs and improve the quality of patient care. The aim of this study is to design minimum data set to develop a kidney transplantation registry in Iran to improve the quality of care for people with end-stage renal disease.

Methods

The present research is descriptive-applied. The minimum data set was reviewed and evaluated in expert panel meetings. The various elements of the minimum data set were discussed, and specialists in urology, nephrology, health information management, and medical informatics presented their views.

Results

The characteristics of the kidney transplantation registry in the form of eight axes of purpose, structure, data sources, minimum data set, classification systems, data processing and reporting, distribution and access to information, and data quality were extracted and finally these characteristics were approved by experts. The relevant tables were validated and were within the acceptable range from the point of view of experts.

Conclusion

In developing a kidney transplantation registry in Iran, the necessary requirements and features for designing a web-based registry have been considered. The prototype of this registry in the country will help to collect higher quality data. It is hoped that by developing this registry, a step will be taken to better manage the information on people with end-stage renal disease, provide better services to these patients, and facilitate related research.